39s.full - Copyright#ERS Journals Ltd 2003 European...

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Particulate air pollution and hospital admissions for cardiorespiratory diseases: are the elderly at greater risk? H.R. Anderson, R.W. Atkinson, S.A. Bremner, L. Marston Particulate air pollution and hospital admissions for cardiorespiratory diseases: are the elderly at greater risk? H.R. Anderson, R.W. Atkinson, S.A. Bremner, L. Marston. # ERS Journals Ltd 2003. ABSTRACT: A systematic literature review suggests that particulate air pollution is associated with daily admissions for both respiratory and cardiac diseases in people aged w 65 yrs. A model of acute effects is proposed which shows how admissions can be brought forward by a relatively short period of time as well as events being added that would not have happened at all except for air pollution. A model of the effects of air pollution on chronic disease is proposed that provides the background of long-term vulnerability upon which the increased short-term vulnerability is superimposed. A study of daily hospital admissions in London shows that for respiratory disease the relative risks of admission associated with particles reduce with increasing age, while for cardiac disease, there is no trend. When the attributable risk is estimated using baseline admission rates for respiratory disease, it is children who have the highest attributable risk, followed by the elderly. For cardiac disease there is a steep increase in attributable risk with age, reflecting the dominant influence of baseline risks. The attributable risk for cardiovascular disease in the elderly is considerably greater than for respiratory disease, due to higher baseline admission rates. Eur Respir J 2003; 21: Suppl. 40, 39s–46s. Dept of Public Health Sciences, St George 9 s Hospital Medical School, London, UK. Correspondence: H.R. Anderson Dept of Public Health Sciences St George 9 s Hospital Medical School Cranmer Terrace London SW17 0RE UK Fax: 44 2087253584 E-mail: [email protected] Keywords: Ambient particles cardiorespiratory diseases elderly hospital admissions Received and accepted: April 12 2002 In the United Kingdom (UK), a series of studies have been initiated in the last decades by the concern that, despite the fall in air pollution levels since the 1950s, there might still be adverse effects at current levels. In 23-yr-old subjects from the 1958 national birth cohort in the UK [1], phlegm symptoms increased with increasing black smoke (BS) levels with evidence of a plateau. Among a subsample examined at age 34–35 yrs [2], those currently using gas for cooking at home had a significantly reduced forced expiratory volume in one second (-70 mL) compared with those who used electricity for cooking. In December 1991, London experienced an air pollution episode with elevated concentrations of nitrogen dioxide (NO 2 ) and moderate increases of BS. Mortality was increased for all causes (relative risk=1.10) and cardiovascular diseases (1.14), and, nonsignificantly, for all respiratory diseases (1.22). In the elderly ( o 65 yrs) the relative risk of hospital admission was increased for obstructive lung diseases (1.43) [3]. Epidemic of asthma was not associated with such an
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